Daily News Updates - Health Insurance News

Accepted or Excepted Health Insurance?, Pt.3 – Which plan to get?

Previous…

Now, to the meatier jargon, starting with ‘capitated health insurance’.  This type of insurance is where a health insurance provider will typically pay a doctor a low fee per enrollee if they will be available to see the health insurance provider’s patients.  This is typical with many HMO plans.  It doesn’t require that the doctor see any of those patients, just be available.  Of course there are some ‘accountability measures’, but the point is that there is little incentive to make a point just to see you.  Since the pay is low and most doctors are already busy seeing a host of other patients, you may find yourself on the bottom of their list.  Because they often encourage under-treatment, they are not the best health insurance coverage to be depending on.

* As for Medicare health insurance, this is not a typical choice on the list. If you qualify, go for it.  But be aware of some caveats here, as well.  A new option offered in some of these plans, such as the ‘Medicare Advantage Programs’ are actually capitated health insurance plans.  As such, they are treated more like the other capitated plans, similar to HMOs. Dr. Cary warns us that our chances “may dramatically reduce the likelihood” of your choices.

As to non-capitated plans, obviously these are much better.  They are employed by all PPO plans and non-PPO standard health insurance plans.  They are even found in some HMO plans.  So this is the plan to go after.  Read the fine print and ask the right questions to ensure you are getting this type, before you make that decision. Many thanks to the good Dr. Cary Presant for his fine article.

Note: As far as de-capitated insurance plans, you may want to look into these if you have the tendency to lose your head at times (or forget where you left it).  As far as I know, there are none available at this time, but good luck..